Some insurance companies require prior authorization for Synagis® (Palivizumab) administrations. Prior authorization (sometimes called pre-authorization) requires that a request for medication be approved or denied by the insurer before administration begins. The Synagis® Reimbursement Hotline can help you and your patients collect information necessary for obtaining prior authorization. However, only the insurance company can authorize the treatment.
This worksheet presents information that most insurance companies will need to process a request.
Insurance Verification Worksheet
Prior to beginning treatment, a provider or patient may want to know what type of coverage and reimbursement an insurer will provide. The Hotline can perform an insurance verification for you, or you can contact the insurer directly to verify benefits. This worksheet will help you collect the necessary information for an insurance verification. If you prefer that the Hotline perform this task, we would need to receive worksheet information either by phone or by fax.
For Assistance, call our Hotline at 1-877-633-4411
Manufactured by: MedImmune, Inc. Gaithersburg, MD 20878
U.S. Govt. License No. 1252 (1-800-949-3789)
Co-marketed by: Ross Product Division, Abbott Laboratories, Inc., Columbus, OH 43215-1724
